pediatric covid-19 outpatient clinical management pathway...expanded details confirmed covid-19...

Pediatric COVID-19 Outpatient Clinical Management PathwayQuicklinks: Expanded details

Provider resources Patient resources

Risk stratify patientHigh risk: Monitor Q daily x 14 daysAverage risk: Monitor and reassess Q2 days x 14 days

Updated: Dec. 11, 2020Page 1 of 9

Background

ahs.ca/covidphc

Confirmed COVID-19positive pediatric patient

Caregivers should have information on self-managing symptoms, with action plan for deterioration

Risk factors

Moderate or low clinical concern

High clinical concern

Screen for red flags

Flags present

Patient requires in-person assessment EMERGENT patient:- Activate EMS by calling RAAPID/911URGENT patient:- Call RAAPID

More info

F/up in 24 hrs to reassess For specific concerns related to COVID-19 management, consider Specialist LINK COVID-19 pediatric ID tele-advice Community pediatrician tele-advice is available for questions about the status of a child, or contact the on-call pediatrician

Clinical assessment Determine health status today. Reinforce isolationDon’t forget safety net flags as part of assessment

No flags present

Adult pathway

Establish/confirm date of onset of symptoms More info

High risk: Defined as any of the following: Age < 1 year Underlying conditions including:- Immunocompromise- Comorbidities including heart disease, lung disease, neurological disease, diabetes mellitus

Does anyone else in household have

COVID-19 symptoms?No

YesChild

Caregiver?

Adult

Follow adult COVID-19 Primary Care Pathway

No

Yes

Alternative caregiver present?

Yes

High risk social situation: Requires

evaluation, close follow-up and supports

No

Follow Pediatric Testing & Isolation Pathway

More info

ISOLATE child for 10 days from onset of symptoms or until symptoms resolve, whichever is longer Clearance testing not recommended unless directed by Medical Officer of Health or via COVID-19 pediatric tele-advice

Specialist LINK tele-advice

Isolation information

Safety net flags

Red flags

Specialist LINK COVID-19 pediatric ID tele-advice

Isolation information

Self-managing symptoms

When patient is stable

If never symptomatic,

isolate child for 10 days from date of test.

After this, child no longer considered infectious. Close

contacts must isolate for 14 days from date of last contact with child

Rapid deterioration is most common

during week 2 from symptom onset

Clinicalassessment

https://www.specialistlink.ca/https://www.specialistlink.ca/https://www.specialistlink.ca/files/CZ_COVID_Adult_Pathway.pdfhttps://www.specialistlink.ca/files/CZ_COVID_Adult_Pathway.pdfhttps://www.specialistlink.ca/files/CZ_COVID_PediatricTestingIso_Pathway.pdfhttps://www.albertahealthservices.ca/topics/Page16956.aspx

Last updated: December 11, 2020 Page 2 of 9 Back to algorithm

EXPANDED DETAILS

Confirmed COVID-19 pediatric patient This pathway is intended to be followed for pediatric patients who are confirmed as positive for COVID-19.

Core symptoms that prompt COVID-19 testing • Cough

• Fever

• Shortness of breath

• Loss of sense of taste or smell

Other COVID-19 symptoms One symptom: Stay home for 24 hours, get tested if symptoms don’t improve Two or more symptoms: Get tested and stay home until well or test is negative • Sore throat

• Runny or stuffy nose

• Painful swallowing

• Chills

• Headache

• Muscle or joint aches

• Feeling unwell or fatigue

• Nausea, vomiting, diarrhea or unexplained loss of appetite

• Conjunctivitis (commonly known as pink eye)

Source: https://www.alberta.ca/covid-19-testing-in-alberta.aspx#toc-0

Virtual appointment information It is recommended to follow patients with COVID-19 symptoms in primary care through virtual means when possible.

Information about virtual care can be found at: https://www.albertadoctors.org/leaders-partners/ehealth/virtual-care

Establish or confirm date of onset of symptoms Establishing the date of symptom onset is important for establishing the release date from isolation. The duration of

isolation is a minimum of 10 days from the onset of symptoms or until symptoms resolve – whichever is longer. You

can refer to the Isolation Information for more details.

Self-managing symptoms For specific patient advice on how to self-manage, please visit:

• https://myhealth.alberta.ca/Alberta/Pages/How-to-manage-symptoms.aspx

• https://myhealth.alberta.ca/Alberta/Pages/Coronavirus-Disease-(COVID-19)-Care-Instructions.aspx

There is increasing evidence that smoking cessation may help to reduce the impact of COVID-19. Patient information

and supports can be found at https://www.albertaquits.ca/topics/smoking-vaping-covid-19.

Clinical assessment (apply as appropriate based on patient’s age) • Central Nervous System o Is the child their normal self in between the fever episodes?

https://www.alberta.ca/covid-19-testing-in-alberta.aspx#toc-0https://www.albertadoctors.org/leaders-partners/ehealth/virtual-carehttps://www.specialistlink.ca/files/IsolationInformation_Nov6_2020.pdfhttps://myhealth.alberta.ca/Alberta/Pages/How-to-manage-symptoms.aspxhttps://myhealth.alberta.ca/Alberta/Pages/Coronavirus-Disease-(COVID-19)-Care-Instructions.aspxhttps://www.albertaquits.ca/topics/smoking-vaping-covid-19


o Does the child seem lethargic?

• Respiratory o Is the child breathing faster than usual?

o Are the muscles over the child’s ribs or neck pulling in when they breathe?

o Is the child’s nose flaring when breathing?

o Is the child grunting?

o Is the child blue around or inside the mouth?

• Dehydration o Does the child have any vomiting or diarrhea?

o When the child cries, do they make tears?

o Has there been a change in the number of wet diapers or the number of times the child urinates?

o Is the child able to tolerate fluid intake well?

• General o Does the child have a new rash?

o Are the child’s eyes red even between fever episodes?

o Are the child’s lips or tongue more red than usual?

Safety net flags • Socially isolated

• Lack of caregiver support (e.g. caregiver also has suspected or confirmed COVID-19)

• Inability to maintain hydration (e.g. vomiting, diarrhea, poor fluid intake, cognitive impairment)

• Food/financial insecurity

• Challenges with health literacy

• Concerns with ability to manage pediatric patient

Red flags

• Respiratory distress: tachypnea, cyanosis, indrawing, accessory muscle use, grunting

• New onset of acute GI symptoms: abdominal pain, vomiting, diarrhea

• Reduced urine output or signs of dehydration

• Rash, non-purulent conjunctivitis, or muco-cutaneous inflammation

• Fever with temperature > 38 C for three consecutive days or more

• Signs of shock: lethargy, non-responsiveness, altered mental status

Emergent patient • Respiratory: cyanosis, indrawing with accessory muscle use, grunting

• Signs of shock: lethargy, non-responsiveness, altered mental status

Urgent patient • Respiratory: tachypnea

• New onset of acute GI symptoms: abdominal pain, vomiting, diarrhea

• Reduced urine output or signs of dehydration

• Rash, non-purulent conjunctivitis, or muco-cutaneous inflammation

• Fever with temperature > 38 C for three consecutive days or more


High risk social situation In a situation where the only available caregiver of a pediatric patient may be unable to provide enough support

because they also have COVID-19 or other barriers or struggles, consider the following options:

• Seeking assistance from a PCN/other social worker to help address safety net flags

• Directing the household to 211 Alberta (www.ab.211.ca for links and live online chat; call 2-1-1, text 2-1-1)

• Referring the household to Children’s Services: https://www.alberta.ca/childrens-services-office-locations.aspx

Isolation information A. Isolation requirements

1. Albertans are legally required to isolate for 10 DAYS or until symptoms resolve (whichever is longer) if they:

• Test positive for COVID-19

• Have core COVID-19 symptoms that are not related to a pre-existing illness or health condition (e.g. cough,

fever, shortness of breath, loss of sense of taste or smell) AND do not get tested OR are waiting for a test result

• Children under 18 are exempt from mandatory 10-day isolation for runny nose or sore throat but should still stay

home for 24 hours or until their symptoms are gone (whichever is longer) before they go back to school or have

contact with others.

2. Albertans are legally required to isolate for 14 DAYS if they:

• Return to or enter Alberta from outside Canada (unless they are participating in the International Border Testing

Pilot Program: https://www.alberta.ca/international-border-pilot-project.aspx)

• Test negative for COVID-19 AND have known exposure to the virus

• Are a close contact of someone who tests positive for COVID-19 (e.g. provides care, lives with, or has close

physical contact without appropriate use of personal protective equipment, or comes into direct contact with

infectious body fluids)

o If a close contact tests positive for COVID-19, they become a case and must restart their isolation period for an

additional 10 days from the onset of symptoms or until symptoms resolve (whichever is longer) OR if the close

contact tests positive for COVID-19 and is asymptomatic, they must restart their isolation period for an

additional 10 days from the date they had the COVID-19 test (e.g. the original 14-day isolation no longer

applies in either of these situations because they are now considered a case and no longer just a contact)

3. Albertans are NOT legally required to isolate if they:

• Have ILI (influenza-like illness) symptoms AND test negative for COVID-19 AND have NO known exposure to

the virus, but they cannot return to school or work until ILI symptoms resolve

Source: https://www.alberta.ca/isolation.aspx

B. Isolation guidance Isolation and Quarantine Information: https://www.albertahealthservices.ca/topics/Page17239.aspx#sick

How to care for a COVID-19 patient at home: https://www.albertahealthservices.ca/topics/Page17026.aspx

Handout: How to care for a COVID-19 patient at home

• English: https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-patient-at-home.pdf

• Arabic: https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-

arabic.pdf

http://www.ab.211.ca/https://www.alberta.ca/childrens-services-office-locations.aspxhttps://www.alberta.ca/covid-19-testing-in-alberta.aspxhttps://www.alberta.ca/international-border-pilot-project.aspxhttps://www.alberta.ca/isolation.aspxhttps://www.albertahealthservices.ca/topics/Page17239.aspx#sickhttps://www.albertahealthservices.ca/topics/Page17026.aspxhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-patient-at-home.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-arabic.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-arabic.pdf


• Simplified Chinese: https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-

home-simplified-chinese.pdf

• Traditional Chinese: https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-

home-traditional-chinese.pdf

• French: https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-

french.pdf

• Punjabi: https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-

punjabi.pdf

• Spanish: https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-

spanish.pdf

• Tigrinya: https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-

tigrinya.pdf

• Vietnamese: https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-

vietnamese.pdf

Alberta International Medical Graduates Association: https://aimga.ca/covid-19/

• Isolation information translated into multiple languages as short videos:

o Part 1: What is the difference between self-isolation and isolation?

o Part 2: How to safely isolate

o Part 3: Safety and prevention at home

• English text of content: https://aimga.ca/wp-content/uploads/documents/covid-19/aimga-covid-19-isolation.pdf

C. Isolation for children who attend school AHS published an online resource that will undergo regular updates as isolation requirements for school children

evolve: Guidance for Parents of Children Attending School and/or Childcare. The recommendations in this resource

align with the most current Government of Alberta isolation requirements. However, school boards may establish

additional isolation guidelines that evolve over time. All caregivers are encouraged to consult the isolation

requirements outlined by the school board that oversees their child’s school.

a. For a child who experiences fever, cough, shortness of breath, or loss of sense of smell or taste as a symptom that is new, worsening, or not related to other known causes, refer to this algorithm:

https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-school-journey-a-symptoms.pdf

b. For a child who does NOT experience fever, cough, shortness of breath, or loss of sense of smell or taste but

who DOES experience chills, sore throat, painful swallowing, runny nose, congestion, fatigue, nausea, vomiting, diarrhea, unexplained loss of appetite, muscle or joint aches, headache, or conjunctivitis (pink eye) as a symptom that is new, worsening, or not related to other known causes, refer to this algorithm: https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-school-journey-b-symptoms.pdf

c. For a child who does NOT have COVID-19 symptoms and has been identified as a close contact of a confirmed

case of COVID-19, refer to this algorithm: https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-

school-journey-close-contact.pdf

d. For a child who does NOT have COVID-19 symptoms, they can continue to go to school or childcare. If the child

is notified that they have been in close contact with a confirmed case of COVID-19 or if the child experiences any

COVID-19 symptoms, then refer to the appropriate algorithm above.

https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-simplified-chinese.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-simplified-chinese.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-traditional-chinese.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-traditional-chinese.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-french.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-french.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-punjabi.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-punjabi.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-spanish.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-spanish.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-tigrinya.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-tigrinya.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-vietnamese.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-translated-patient-at-home-vietnamese.pdfhttps://aimga.ca/covid-19/https://aimga.ca/wp-content/uploads/documents/covid-19/aimga-covid-19-isolation.pdfhttps://www.albertahealthservices.ca/topics/Page16998.aspxhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-school-journey-a-symptoms.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-school-journey-b-symptoms.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-school-journey-close-contact.pdfhttps://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-school-journey-close-contact.pdf


D. Talking to children about isolation at home for COVID-19 • Let children know that they are safe. The overwhelming majority of children will only have symptoms of the

common cold, if they have any symptoms at all

• Remind children that is important to prevent germs from spreading every day. They can do this by washing their

hands often, covering their mouths when coughing or sneezing, and not sharing their food or drinks. When

someone at home is sick, it is extra important to follow this plan

• Remind children that the purpose of wearing a mask is to help stop the spread of germs. Let them know that the

mask is only temporary and soon the household will return to “mask-free” with a usual home routine. Let children

know they do NOT have to wear a mask while sleeping

• Listen to children’s questions and concerns. They may have unique concerns, fears, or worries that caregivers

do not think about

• Continue to provide physical comfort to children who are isolating if they need it, such as cuddles and hugs. It is

best to avoid kisses since this is a higher risk for transmitting the virus between people

Follow-up For non-urgent COVID-19 questions, pediatric eReferral Advice Requests are available via Alberta Netcare. This is

for non-urgent questions requiring advice within two to five days. Go to www.albertanetcare.ca/eReferral.htm for

instructions on how to submit a request. For training support, email [email protected] or call 1-855-643-8649.

For other enquiries, email [email protected] or call 1-888-733-3755 (Monday to Friday).

For symptoms persisting longer than 14 days from onset Patients should continue to be monitored until symptom resolution. Isolation should continue for 10 days after

symptom onset OR until core symptoms have cleared, whichever is longer. If the patient remains symptomatic after

10 days, they should be monitored for an additional four days – a total of two weeks after symptoms started. They

should continue to isolate. If patient remains symptomatic two weeks after date of onset of symptoms, contact

Specialist LINK for advice on further investigations, management, and isolation.

If Public Health has discharged a patient from isolation that you feel should still be isolating, consider:

• Public Health has the legal responsibility to require citizens who are diagnosed with COVID-19 to isolate and to

release them from this requirement when they are no longer deemed at risk to spread the disease to others

• There should be alignment between the direction from Public Health and your advice to patients and caregivers.

When this doesn’t happen, consider the following:

o Is there agreement between your records and Public Health identification of the date of symptom onset?

o The patient or patient’s caregiver(s) disclose medical information to you that is unavailable to Public Health

(example -- the presence of ongoing symptoms which would compel you to suggest continued isolation)

o If you are unsure of whether to advise your patient or patient’s caregiver(s) to continue isolation beyond the

date identified by Public Health, or the patient remains symptomatic beyond 14 days post symptom onset, you

may obtain advice from the Specialist LINK COVID-19 Pediatric ID line

http://www.albertanetcare.ca/eReferral.htmmailto:[email protected]:[email protected]


BACKGROUND About this pathway Due to the reopening of schools across Alberta in fall 2020, a team that included specialists from Pediatrics,

Infectious Disease, the AHS primary care team, family physicians, and Primary Care Networks (PCNs) developed

this pathway to help support family doctors to care for pediatric patients who contract COVID-19.

Authors and conflict of interest declaration This pathway was developed and reviewed in August 2020. Names of participating reviewers and their conflict of

interest declarations are available on request.

Pathway review process, timelines This primary care pathway was created with up to date knowledge at the time it was created (updated December

2020). It will be reviewed on a consistent basis as the knowledge and process base evolves. If you have concerns or

feedback please email [email protected] and enter ‘COVID-19 pediatric pathway feedback’ in the subject

line.

Copyright information This work is licensed under a Creative Commons Attribution-Non-commercial-Share Alike 4.0 International license.

You are free to copy, distribute and adapt the work for non-commercial purposes, as long as you attribute the work to

Alberta Health Services and Primary Care Networks and abide by the other license terms. If you alter, transform, or

build upon this work, you may distribute the resulting work only under the same, similar, or compatible license. The

license does not apply to content for which the Alberta Health Services is not the copyright owner.

DISCLAIMER This pathway represents evidence-based best practice but does not override the individual responsibility of health care professionals to make decisions appropriate to their patients using their own clinical judgment given their patients’ specific clinical conditions, in consultation with patients/alternate decision makers. The pathway is not a substitute for clinical judgment or advice of a qualified health care professional. It is expected that all users will seek advice of other appropriately qualified and regulated health care providers with any issues transcending their specific knowledge, scope of regulated practice or professional competence.

mailto:[email protected]


PROVIDER RESOURCES Greenhalgh Trisha, Koh Gerald Choon Huat, Car

Josip. Covid-19: a remote assessment in primary care

BMJ 2020; 368:m1182

https://www.bmj.com/content/bmj/368/bmj.m1182.full.pdf

Information for Primary Care Providers: novel

coronavirus (COVID-19) https://www.albertahealthservices.ca/topics/Page16956.aspx

Specialist LINK COVID-19 Resources https://www.specialistlink.ca/covid19/covid19-resources.cfm

Oxford COVID-19 Evidence Service Team

Nuffield Department of Primary Care Health Sciences

University of Oxford: How should we assess dyspnea

(breathlessness) by telephone or video?

https://www.cebm.net/covid-19/are-there-any-evidence-based-

ways-of-assessing-dyspnoea-breathlessness-by-telephone-or-

video/

Roth Score: Opinion https://www.specialistlink.ca/files/Roth_Score.pdf

Smoking cessation: healthcare provider https://healthcareproviders.albertaquits.ca/resources/covid-19

Advice options

• For RAAPID South, call 1-800-661-1700 or 403-944-4486. Visit https://www.albertahealthservices.ca/info/Page13345.aspx for more details.

Non-urgent advice is available to support family physicians.

• Community pediatrics advice is available in the Calgary Zone via Alberta Netcare eReferral Advice Request (responses are received within five calendar days). This is for non-urgent questions requiring advice within two to

five days. Go to www.albertanetcare.ca/eReferral.htm for instructions on how to submit a request. For training

support, email [email protected] or call 1-855-733-3755 (Monday to Friday). • In the Calgary Zone, specialistlink.ca connects family physicians and specialists in real time via a tele-advice

line. COVID-19 tele-advice options available via Specialist LINK include a COVID-19 line staffed by Infectious

Disease, a COVID-19 Pediatric ID service, Community Pediatrics, and a Maternal Fetal Medicine line. Family physicians can request non-urgent advice online at specialistlink.ca or by calling 403-910-2551. The service is available from 8 a.m. to 5 p.m. (with some exceptions), Monday to Friday (excluding statutory holidays). Calls are

returned within one hour.

https://www.bmj.com/content/bmj/368/bmj.m1182.full.pdfhttps://www.albertahealthservices.ca/topics/Page16956.aspxhttps://www.specialistlink.ca/covid19/covid19-resources.cfmhttps://www.albertahealthservices.ca/info/Page13345.aspxhttp://www.albertanetcare.ca/eReferral.htmmailto:[email protected]://www.specialistlink.ca/http://www.specialistlink.ca/


PATIENT RESOURCES Information for Albertans: COVID-19 https://www.albertahealthservices.ca/topics/Page16997.aspx

COVID-19 information for Albertans

https://www.alberta.ca/coronavirus-info-for-

albertans.aspx?utm_source=google&utm_medium=sem&utm_campaig

n=Covid19&utm_term=beinformed&utm_content=v7&gclid=EAIaIQobC

hMI-obwtuPK6AIVeyCtBh1ijAQUEAAYASAAEgLsQPD_BwE

How to manage symptoms

https://myhealth.alberta.ca/Alberta/Pages/How-to-manage-

symptoms.aspx

Smoking cessation https://www.albertaquits.ca/topics/smoking-vaping-covid-19

https://www.albertahealthservices.ca/topics/Page16997.aspxhttps://www.alberta.ca/coronavirus-info-for-albertans.aspx?utm_source=google&utm_medium=sem&utm_campaign=Covid19&utm_term=beinformed&utm_content=v7&gclid=EAIaIQobChMI-obwtuPK6AIVeyCtBh1ijAQUEAAYASAAEgLsQPD_BwEhttps://www.alberta.ca/coronavirus-info-for-albertans.aspx?utm_source=google&utm_medium=sem&utm_campaign=Covid19&utm_term=beinformed&utm_content=v7&gclid=EAIaIQobChMI-obwtuPK6AIVeyCtBh1ijAQUEAAYASAAEgLsQPD_BwEhttps://www.alberta.ca/coronavirus-info-for-albertans.aspx?utm_source=google&utm_medium=sem&utm_campaign=Covid19&utm_term=beinformed&utm_content=v7&gclid=EAIaIQobChMI-obwtuPK6AIVeyCtBh1ijAQUEAAYASAAEgLsQPD_BwEhttps://www.alberta.ca/coronavirus-info-for-albertans.aspx?utm_source=google&utm_medium=sem&utm_campaign=Covid19&utm_term=beinformed&utm_content=v7&gclid=EAIaIQobChMI-obwtuPK6AIVeyCtBh1ijAQUEAAYASAAEgLsQPD_BwEhttps://myhealth.alberta.ca/Alberta/Pages/How-to-manage-symptoms.aspxhttps://myhealth.alberta.ca/Alberta/Pages/How-to-manage-symptoms.aspxhttps://www.albertaquits.ca/topics/smoking-vaping-covid-19

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